Osteoporosis (bone thinning) is a condition that weakens bones and makes them fragile, and it often gives no symptoms until a bone breaks; it most often leads to fractures of the wrist, hip and spine [1]. It is detected with a bone density scan (DXA), and a fracture after a simple fall is also a reason to have bone health assessed [1][4]. Exercise, calcium and vitamin D, stopping smoking and preventing falls help protect the bones; in people at high risk of fracture, medicines can reduce that risk [3][4][6].
What is osteoporosis?
Osteoporosis, often called bone thinning, is a condition that weakens bones, making them fragile and more likely to break; it develops gradually [1]. Losing bone is a normal part of ageing, but in some people it happens much faster [1]. In Türkiye, osteoporosis has been calculated to be present in 22.2% of men and 27.2% of women aged 50 and over [5].
Osteoporosis is not the same condition as osteoarthritis. In osteoarthritis the protective cartilage in the joint breaks down and the joint becomes painful and stiff [7]; osteoporosis weakens the bone itself and is not usually painful unless a bone breaks [1].
What are the symptoms, and why is it noticed late?
Osteoporosis is not usually painful until a bone breaks [1]. Because it typically causes no symptoms until a fracture occurs, it is called a "silent disease" [4]; it is often diagnosed only when a fall or a sudden impact breaks a bone [1].
Fractures of the spinal bones mostly cause no symptoms [5]; however, they can lead to long-term back pain, loss of height and a stooped (bent forward) posture [1][4].
What causes it and who is at risk?
Women are more at risk than men; bone is lost rapidly in the first few years after the menopause [1]. The main factors that increase the risk are [1][4]:
- Early menopause or removal of the ovaries
- Taking high-dose steroid (cortisone) tablets for more than three months
- A family history of osteoporosis or of hip fracture
- Thyroid disorders, rheumatoid arthritis and conditions that impair the absorption of nutrients
- Eating disorders and a low body mass index
- Poor nutrition and low vitamin D
- An inactive lifestyle, smoking and heavy drinking
How is it detected? The bone density scan (DXA) and what the result means
If a doctor suspects osteoporosis, they can work out the future risk of fracture with a tool such as FRAX and may request a bone density scan [1]. The bone density scan (DXA or DEXA) is a low-radiation scan that measures bone mineral density at the hip and spine [4]; it is painless and takes 10 to 20 minutes [1].
The scan is not the only criterion: having had a low-energy fracture is also one of the grounds for the diagnosis [5].
The result is compared with healthy young adults and given as a T score; osteopenia is the stage before osteoporosis and does not always lead to it [1]:
- Above -1: normal
- Between -1 and -2.5: reduced bone density (osteopenia)
- Below -2.5: osteoporosis
Which fractures does it cause?
A fracture caused by a minor force that a healthy bone would easily withstand, such as a fall from standing height, is called a fragility fracture [4]. It is most common in the wrist, hip and spine [1]; the upper arm bone near the shoulder is another common site [4][5]. Sometimes even a cough or a sneeze can cause a broken rib or the partial collapse of one of the bones of the spine [1].
Whether surgery is needed depends on the features of the fracture; for a hip fracture, surgery is almost always recommended [4]. Fractures of the spine are assessed by the relevant specialty.
A fracture after a simple fall most likely points to underlying bone weakness and calls for an assessment of bone health; one fragility fracture approximately doubles the risk of another [4].
What helps osteoporosis, and how is it prevented?
Lifestyle factors such as diet and exercise also influence bone health [3]. The main measures are:
- Exercise: weight-bearing exercise, in which the legs support the body's weight (such as brisk walking, dancing or tennis), and resistance exercise are particularly important for bone density; swimming and cycling do not count as weight-bearing [3]. These exercises also improve balance and muscle strength, which reduces the risk of falling [4]
- Calcium: milk, cheese and yoghurt, leafy green vegetables, beans, nuts and dried fruit are rich in calcium [3][5]. Getting calcium from food is generally preferred over supplements [5]
- Vitamin D: its main source is sunlight, and food sources are limited [5]. Oily fish, egg yolks, liver and red meat contain vitamin D [3]. Calcium and vitamin D supplements are recommended for people at high risk of insufficiency and for those taking osteoporosis medicine; a very large dose of vitamin D taken at one time is not advised, because it has been associated with an increased risk of fractures and falls [5]
- Smoking and alcohol: smoking is associated with an increased risk of osteoporosis; stopping smoking and limiting alcohol are recommended [3]
- Preventing falls: removing loose rugs, wearing stable shoes, keeping the floor clear of objects, lighting the way to the bathroom well, and fitting handrails on the stairs and in the bathroom [4]
How is it treated? Osteoporosis medicines
Whether medicine is needed depends on the future risk of fracture; not everyone needs it [1][2]. Medicine is recommended for people who have had a fragility fracture or who are at risk of fracture; calcium and vitamin D alone are not sufficient as treatment [5].
The most commonly used group, and usually the first choice, is the bisphosphonates [5]. They slow the rate at which bone is broken down; they usually take 6 to 12 months to work and may need to be taken for 5 years or longer [2]. Other options are medicines with an oestrogen-like effect (SERMs), parathyroid hormone treatments, biological medicines given by injection, and hormone replacement therapy for women around the menopause [2].
According to a Cochrane review of one medicine from the bisphosphonate group, in postmenopausal women at higher risk of fracture it probably reduces fractures of the spine and may also reduce hip and wrist fractures. In women at lower risk it may make little or no difference to hip and wrist fractures [6].
Bisphosphonate tablets can irritate the food pipe; damage to the jaw bone (osteonecrosis) and unusual fractures of the thigh bone are rare but serious side effects [2][5]. The choice of medicine and the length of treatment are decided by the treating doctor according to the person's condition and fracture risk [2][5].
Which department and which doctor deals with it?
The fracture is treated by orthopaedics and traumatology. The medical treatment and long-term follow-up of osteoporosis are most often run by another department: the orthopaedic surgeon often identifies the need for a bone health assessment, and the patient continues treatment with a doctor who works in this field [4].
In Türkiye these patients are mainly managed by specialists in physical medicine and rehabilitation, endocrinology, rheumatology and internal medicine, and also by specialists in orthopaedics and in gynaecology [5]; which department deals with it varies from hospital to hospital.
When not to wait
In the following situations seek care without delay; in the first one go to an emergency department [1][4][5]:
- You suspect a fracture in the wrist, hip, shoulder or back after a fall or a blow; keep the area still
- Back pain that began after a simple movement such as coughing, sneezing or bending forward, or back pain with no explanation
- You have lost height or your back has begun to bend forward; these can be signs of a fracture of the spine and call for an X-ray of the spine
- You have had a fracture after a simple fall and your bone health has not yet been assessed
Frequently asked questions
- Does osteoporosis cause pain?
- Usually not; it is not painful unless a bone breaks [1]. Fractures of the spine, however, are a common cause of long-term pain [1].
- Are osteoporosis and osteoarthritis the same thing?
- No. In osteoarthritis the protective cartilage in the joint breaks down and the joint becomes painful and stiff [7]; osteoporosis weakens the bone itself and is not usually painful unless a bone breaks [1].
- Which foods are good for osteoporosis?
- Milk, cheese, yoghurt, leafy green vegetables, beans and nuts are rich in calcium; oily fish, egg yolks and liver contain vitamin D [3][5]. Food sources of vitamin D are limited, and its main source is sunlight [5].
- Do osteoporosis medicines prevent fractures?
- They can reduce the risk in people at high risk of fracture: according to a Cochrane review, one medicine from the bisphosphonate group probably reduces fractures of the spine in women at higher risk and may also reduce hip and wrist fractures [6]. The choice of medicine and the length of treatment are decided by the treating doctor [2].
- I have had a fracture; should I have a bone density scan?
- A fracture after a simple fall most likely means there is underlying bone weakness and approximately doubles the risk of another fracture, so bone health needs to be assessed [4]. As part of the assessment the doctor may request a bone density scan (DXA) [1][4].
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Osteoporosis. NHS (nhs.uk), 2022. nhs.uk
- Osteoporosis: Treatment. NHS (nhs.uk), 2022. nhs.uk
- Osteoporosis: Prevention. NHS (nhs.uk), 2022. nhs.uk
- Fragility Fractures: Frequently Asked Questions. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Updated approach for the management of osteoporosis in Turkey: a consensus report. Archives of Osteoporosis (Kirazlı Y, et al.), 2020. pubmed.ncbi.nlm.nih.gov
- Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews (Wells GA, et al.), 2025. pubmed.ncbi.nlm.nih.gov
- Osteoarthritis. NHS (nhs.uk), 2023. nhs.uk
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
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